| NPI | 1871014779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024175334) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024175334) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2022-12-12 |